Healthcare Provider Details

I. General information

NPI: 1982213617
Provider Name (Legal Business Name): JODI MARIE FRYDENDALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI MARIE TICHENOR RN

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4451
US

IV. Provider business mailing address

409 SHELTON DR
SMITH CENTER KS
66967-3301
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-4521
  • Fax:
Mailing address:
  • Phone: 785-282-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81263-042
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114389
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: